Online STEMER Application

Personal Information:

First Name: Last Name:
Mailing Address:
City: State: Zip Code:
Phone Number: Social Security:
E-mail: DOB:(mm/dd/yyyy) / /
 U.S. Citizen  Non-Citizen  U.S. Resident

Additional Information:

Parent/Guardian: Relationship to Applicant:
Parent/Guardian Phone: Parent's E-mail:
High School Attended: GPA:

ACT Score:

Overall: English: Math: Reading: Science Comprehension:

SAT Score:

Overall: Reading: Math: Writing:

School Information:

Intended University Major:
Post Graduation Goals:

Course Name:                                                                                                       Grade: